General Question

Is it wrong to kick poor patient out of hospital?

There were many cases where something like this happen in our society. I have seen in many news that poor people were kicked out of the hospital for their inability to afford medical treatment. Some get the simplest treatment (that is very insignificant to their illness/injuries), the others get nothing at all, a hush, and some rude words such as “We’re very sorry but we can’t save everyone in this world” from the receptionist nurse. Heavily sick patients that need to stay in the hospital were forcibly returned to their home (if they have one) with no medical supply and with only ice on their head. Poor mothers that gave birth in a hospital were forced to stay there until they can pay for medical services. And many more. It seems like they’re all inhumane and unethical.

If we take a moment a rethink again, is it really that wrong for hospitals to abandon their poor patients? Hospitals need money to as their fuel to keep on running. If they treat all poor people for free then they’ll eventually run out of medical support to sustain other patients that can afford to pay.

What if hospitals can afford to treat these poor people? Any poor people could become careless toward their own healthiness, and worse, do not fear or could cause deliberate injury toward themselves considering that they will always get free treatment from hospital.

We’re talking about poor people that usually do not have any kind of retirement insurances or medical supports, and countries that lack decent attention from their governments.

54 Answers

If it’s the first time or maybe a second or third time they will get some treatment. But it’s rather bad to keep all the poor people in for free. And it’s not because of the bills mainly because when things get rough for them they will turn to a hospital for “free care”.

What country are you talking about? In the US it is illegal to kick someone out of the hospital if they need services but can’t pay. You can show them the door as soon as they are stabilized. You can recommend they receive further services. But if they can’t afford those services in a non-hospital setting (doctors and other providers that aren’t hospitals are not required to help people regardless of ability to pay), they won’t get them. So they will get sick again and end up in the hospital again.

Care given to people who can not pay is called uncompensated care. Medicaid gives extra money to hospitals that have a larger uncompensated care burden in order to make sure those hospitals stay in business. Other hospitals pay for poor patients by charging more to insured patients. That is called cost shifting.

People who can’t afford care get the care in hospitals and then don’t pay for it. Inability to pay hospital bills is the single largest cause of personal bankruptcy in the US. A lot of people are afraid to get care because they can’t pay. So they don’t get care until the last minute. Obviously there are unneeded deaths as a result. There are also much worse illnesses as a result.

Too many people don’t know the law. I guess that’s good for hospitals and insurers because people die instead of becoming liabilities on the chart of accounts. But it hurts society.

However, that’s the way capitalism works. If you can’t get care and you don’t know you can get it, then you die. Insurers make bigger profits.

People in the US believe that “competition” is the best way to keep costs down. So, while every nation with an advanced economy other than the US offers universal health insurance, the US doesn’t. And while every other nation in this category has better health outcomes than the US, the US has a health care system with first world technology and third world outcomes. If you’re rich, you get the best health care in the world. If you’re poor, you die. On average, the US health system is worse than Cuba’s system. So much for capitalism.

Yes. It is wrong to kick poor people out. It is unnecessary and it is more costly that giving them care. But so what? You gotta have capitalism or costs will get out of control. Never mind that the US has the highest per capital health care costs of any nation in the world. Capitalism doesn’t work. But then, it’s capitalism, so who cares?

Whether it’s right or wrong is really just a matter of the particular societies goals and priorities. The actions you describe are only right or wrong in the context of the society in which they occur.

On the whole do I think we should we be abandoning those who can’t afford to keep up for that reason alone? No; but even then, that only goes so far. However every exception one grants makes it easier to make another and that’s something to be very, very, careful of.

@wundayatta Could be any poor countries, such as Indonesia as an example. The examples I stated here were taken from my own experience by observing such situations in own country. I must admit that you just gave a very thoughtful perspective!

@Zaku So it depends on the money? Generally, people that need the most costly medical treatment are people that need more medical attention due to the state of their illness.

Why is it OK for a hospital to treat poor people with lesser illness, but not OK to treat people that succumb from life-threatening diseases that need expensive treatment?

Hospitals are meant for acute (short term) care. They are meant for people to go in with an immediate medical issue, get the care they need for that issue, and then the person is supposed to follow up with their doctor for their long term care needs. It stinks that our healthcare system leaves a lot of people unable to get that long term care, but that is not what hospitals are for. So, once a patient is stable, it’s time for them to move on so that the other people needing immediate care can get it.

No. Illness is not something the rest of us have any control over. There is absolutely no reason for us to have to pay for the medical treatment of the rest of the world, or even of the nation. This sounds rather harsh, but what if you extended this practice to everyone on the planet? Sorry, but this is the way the universe works. Ability to pay, like intelligence and beauty, are unevenly distribulted, and no amount of wailing and hand-wringing ( OR politically correct bullshit ) are going to change it until we find some way to raise everyones living standards.

Just as an aside, if the group does not hold the good of the individual above its own, the reasoning that allows a society to deny medical care based on the potential patients ability to pay can very easily be applied to any kind of “core” service for fee model, bound only by the goals of those who define the acceptable exclusions.

The solution is alive and well in the Canadian health care system. Health should be mandatory in the U.S. because those who struggle to meet ends dues, they are mostly surviving to pay rent. Of course Canada also doesn’t spend much militaristically as the U.S. does.

@CaptainHarley Good point, but my thoughts are that there is no reason for any American to even come close to that sort of situation unless you believe that a highly unequal distribution of wealth if a good thing. I mean, it’s one thing if you live in a mansion while I live in a barely habitable apartment, but it seems that many in America see no problem with a few people owning multiple mansions while millions don’t even have a cardboard box in an alley to be “The way things are supposed to be”.

What is the point of being the richest, most powerful nation on Earth if we can’t afford a little charity? Granted, I feel that we should take care of our own first, and we really shouldn’t be responsible for fixing all the worlds problems, but I can’t shake the feeling that extreme inequality is considered a virtue these days. We should have no problem raising the quality of life for all Americans, at least to the point where we all can afford to live self-sufficiently (pay our own rent, buy our own food and insurance…), yet thinking like that quickly earns you the label “Socialist”. Isn’t there a happy medium?

Look, we don’t “kick people” out of the hospital. We discharge them when their clinical situation warrants a discharge. Hospitals are probably one of the most dangerous places on Earth and nobody in their right mind should want to spend one second longer than they have to in one.

@CaptainHarley Would you be in favor of removing the requirement that hospitals serve everyone?

Not that we are talking about this, but the only way to introduce competition into the health insurance system is to eliminate the mandate for hospitals to serve everyone. In this way, hospitals could choose how much (if any) charity care they wanted to give.

Hospitals could turn away anyone they wanted. There would be no uncompensated care burden. Insurers could pay only for the care their insureds need instead of for other people’s care. Well, not quite. Actually, we’d have to get the government out of insuring anyone—not the old, not the poor, not the veterans of the armed services or their families.

Private insurance would be all there was. The government would be like any other employer. They could self-insure and negotiate with providers, but they could not legislate prices; only negotiate them. Your parents would see their insurance premiums rise quite a bit, I would think. They’re elderly, and Medicare doesn’t bring in nearly enough to actually cover costs. They just make the hospitals take what they are willing to pay, forcing hospitals to shift costs onto private insurers.

So maybe your parents could afford higher premiums, or maybe they would choose lower coverage levels and hope they stay well. If they get sick… well, if they can’t pay for it, the hospital doesn’t have to take them in. Or they might decide to pay for health, but sell their house to pay for it and live in a smaller apartment. Or if they are already renting, maybe they would stop paying the rent and beg the landlord to let them stay on.

But you know, old people use the most health care and most that is used in the last month of life. Why? Isn’t it kind of a waste of money? If we stopped paying for the health care of our parents when it starts costing a thousand dollars a day, maybe we could save a lot of money, and health insurance could cost a lot less.

And as for insuring the rest of the world—the funny thing is they don’t need it. Most of the rest of the world has health insurance. The ones who don’t can’t get here, and even when they do, they are afraid to use health services because they don’t want to get caught.

What a vision! The inspiration of a genius parents everywhere will surely be proud of children who are such creative thinkers!

@Rarebear I must say that not every ‘reality’ is revealed in reality shows. When interviewed, most of the hospitals personels will always try to elude the fact that they were mean on poor patients. Only in newspapers, those victims that were mistreated by hospital can voice the reality. Nevertheless, I dare to conclude poor people in my country receive bad medical attention from hospital.

Hospitals have a duty to care for their patients. Part of that duty is to get them out of the hospital as soon as possible. Not only to make the beds available for others that need them, but to limit the spread of infections.

Some of the more virulent and resistant strains of bactieria and viruses seem to thrive in hospital settings. The quicker they get someone out the less likely there is going to be staff infections and such.

To someone unfamiliar with the situation it may look like they are kicking the poor person out because they can’t pay.

@wundayatta Italy, a first-world country that has universal health care, does not have the United States’ bleeding-edge technology (they are some 20 years behind us in that respect), and you have to bring your own toilet paper and silverware to the hospital with you. Money is not endless, and so something is going to have to take a hit.

@Rarebear One of them, as I remember is RS Adam Malik Medan (and I don’t remember the name of the personel they interviewed. I don’t think he’s an important person to remember, if you want to know why). And that isn’t the only hospital that mistreated their poor patients. I hope you don’t expect me to give you a link as there’s no written source about this issue in the internet. Perhaps you know another better way for me to prove that to you.

@RarebearThis is one of the example (I must apologize that I couldn’t find any English version that explain this issue). I won’t translate all for you but I’ll translate those grey words below the picture of a woman. (The title is RSCM expelled poor patients).

Tariyu (35) was giving milk to Rangga (4 months), her kid that was diagnosed with ‘a disease that is caused by lack of proper nutrition’, Friday (28/3). Hospital denied to care for Rangga since his parent didn’t have health insurance for poor people.

And I still saw another issues on TV a week ago from other hospital. It’s fine if you don’t trust me but it doesn’t mean these hospital mistreatment toward poor people aren’t happening in my country.

What? You take a single article in a website in a language that nobody except you can read and generalize it to all hospitals? That’s unconscionable. It may be true that in whatever country you live people are kicked out of the hospital, but where I live and work in the United States, we treat people until they are ready to be discharged from the hospital, and then we try to find places for them to go if they are homeless. If we cannot, we do discharge them anyway because THEY ARE BETTER and we cannot cure their social situation. We do not discharge people because they cannot pay.

@Your_Majesty Well, because it seems to me that there is a limit to what other people are obliged to do to help others, and as humanitarian and anti-capitalist as I am, I do think cost has something to do with it, at least if the hospital operates on the basis of money. Really to me it’s about resources, and what is a fair share to give to one person, when the use of extreme resources for one person could start to impact the ability to help others. Money is an approximation, but even on in a moneyless society, there would still be a limited amount of doctors, equipment and supplies to allocate to one person. At some point, if you decide to help one person at huge expense, you are depriving others. A million dollars represents a huge amount of resources being allocated to one person (unless it’s mostly there for reasons of legal corruption, insurance corruption, billing corruption, pharmaceutical industry corruption, or something, which a lot of US medical “costs” actually often are).

There are cases where the actual costs are low and the benefits (or consequences of bad treatment) to the patient is high. I think these should always be provided, and poor patients should be given a sliding scale bill that they can afford.

Then there are cases where the actual costs are very very high, and if no one is willing to pay for it, then I don’t think doctors are obliged to bankrupt themselves, and I also don’t think they should serve a few expensive unpaid cases if it means it would reduce their ability to serve others in need (which I imagine it would if they had to give anyone any treatment no matter what).

Somewhere between the extremes is a grey area where a line needs to be drawn.

@Nullo – Toilet paper and silverware are cheaper than hospital bills. Also, not everyone needs bleeding-edge care. Twenty-year-old medical technology is sufficient for many things, and would keep costs down. Ask someone who can’t get any care at all, if they would take the level of care that was provided to most folks in 1991, and I’m sure you’d have a hearty “yes please!”

We shouldn’t give care because it’s a “human right” or an “entitlement.” We should give care because we’re thinking and feeling people who are better than animals.

@laureth Many Conservatives take issue with the Universal Declaration of Human Rights for the reason @CaptainHarley states.

To my mind, that is blatantly saying that the provider’s right to profit trumps your right to live, which raises all sorts of issues like negating human rights in general (your right to profit entitles you to do whatever you want to other humans) but that it’s just my opinion.

@Rarebear Perhaps you miss a point of this question. We’re talking about poor countries. You based your perception only on US alone, which wouldn’t surprise me since it’s very a rich and developed country so your point it irrelevant. It’s ridiculous if you ask for another sources when you know they’re evident but not available in English, English isn’t the only language people can use as information sources.

Generally, poor countries would have worse medical management compare to richer countries. People who can’t afford to pay will get the simplest or no medical attention at all from hospital.

The point of insurance is to spread the risk. The cheapest insurance comes when we spread the risk over the widest group. The widest group, of course, if the entire population.

You could say you don’t want to pay for other people’s insurance, but the problem is that you are already paying for their health care, in the US. However, because they are uninsured, you are paying a huge premium for their health care. If you paid their insurance premiums, you you actually be saving money.

It’s up to you. You can let people hang out to dry and pay extra for the privilege, or you can pay for their health insurance and save money. Myself, I prefer to save money. Conservatives? Seem to put ideology before self-interest. I don’t get it since they are usually accused of being selfish. In this case, they are not. They love the health insurers so much, that they want to guarantee the insurers more profits than they would otherwise be able to achieve if everyone was insured under the same program.

Why do conservatives do this? Ideology. Even though there is no fair competition in the health insurance industry, they insist on making it look like there is competition. When I last did a study on this, it looked like it cost us (collectively) nearly a trillion dollars a year. We, as a people, agree to pay for the sickest population (the poor and the elderly) and we let the health insurers pay for the healthy. In this way, the insurers get to make a lot of money at the taxpayers expense (since Medicare and Medicaid have to pay for the really sick people).

We are subsidizing the private health insurance industry because of ideology. Purely because of ideology. Ideology costs us a lot of money. But we’re Americans. Ideology comes before practicality. We close our eyes and ignore reality in favor of ideology. It’s pretty sad. I don’t think that anything can be done about it either. Facts do not appear to matter to very many people. I don’t know if that is ideology, or they can’t understand the fact.

@Rarebear“We’re talking about poor people that usually do not have any kind of retirement insurances or medical supports, and countries that lack decent attention from their governments”.

It’s not that hard to see those as the common characteristics of most poor countries. In the end, we will be talking about hospital management regarding poor countries so why won’t we just stick to the topic rather than discussing minor/insignificant issues. If motivation still in heart.

@CaptainHarley – I believe that when you hear “we should care for people that need care because we are better than animals,” you assume that the Caring folks will ‘steal’ from the Non-Caring folks (who would rather keep their money, and care-needers be damned). Am I correct?

However, what I meant by my statement is that we (all of us) should realize that we are better than animals, and implement some sort of way for care-needers to receive needed care. The implication (which I believe you missed) is that Caring folks wouldn’t need to “steal money from you involuntarily” if you voluntarily helped to Care, because you’re better than an animal. The next assumption to make is that Non-Caring folks are not necessarily better than animals (assuming, of course, that no animals try to help their injured fellows, which is false).

It seems there are a lot of people out there who think that insurance is unfair. Everybody who has insurance pays in, but only those people who need it benefit. For most people, the people with need are “other people” and so they feel it’s unfair that they’re paying for other people’s medical expenses, and they have a huge problem with that because their money is more important to them than some stranger’s health.

But the beauty of the system is that if someday you are the one with need, those strangers will pay for your need, too.

I like this system, except that I wish everybody had access to care. And if that makes me a “socialist,” so be it. I’d rather be a socialist with a heart than a capitalist without one.

@CaptainHarley These days, there is no middle ground, so those are the only practical choices unless you propose a radical shift in our society to de-polarize us.

Still, I do find it odd that those who are against universal healthcare have no problem with provably corrupt insurance companies. Is it the fact that they trust government even less than those with a proven record of greed, or is it merely the fact that corporations are not seen as having any real power and thus are not a government in and of themselves, or is it solely the part about health insurance being considered optional in much the same way that living indoors is?

Perhaps a combination of those. I know I woud rather trust most corporations than I would the federal government, especially right now. At least you know for a fact that the corporation would emphasize profit.

@CaptainHarley, re “At least you know for a fact that the corporation would emphasize profit.”

If I have two choices about who to have dinner with, one being my mom who I know would get into a fight with me and ruin my evening, or a random acquaintance I met on the Internet (including anyone on Fluther) that I might possibly get along with and have a pleasant evening, I’d choose the stranger every time. Mom’s reliable, but how is reliably bad, good?

@CaptainHarley How many employers still offer pensions? Their insurance package is pretty good too, as is the pay. My mother had a fairly low-level position, retired at 56, and still “earns” almost as much as my wife and I combined do. And look at what we give to the bigwigs. Now compare that to what us normal workers get and I think you’ll see that they are into profit as well.

@laureth Except that if your net-person tuns out to be a colossal turd you can set fire to his clothes and leave. We’re sorta playing for keeps when it comes to health care.
Rather, the choice at hand is to keep a system that works moderately well but works – and will continue to do so indefinitely – or else trade it for a system that’s been talked up a lot but has never seen actual use and might turn out to be a proper lemon. Instead of the jalopy that we currently drive.

I agree with @CaptainHarley. The evil that you know can be planned for. Profit is a simple, reliable, and all-consuming motive. It possesses these qualities regularly enough that one may have a pretty good idea of what to expect, and so may prepare accordingly. But politicians have so very, very many motives, goals, and plans, and probably more that they don’t let on about, many of which you may not like.

@Nullo – It works… but only if you can pay the steep price. It will work for a while… but not forever, at least not for most of us. All the scary budget numbers about what health care will cost in the future are based on the idea that the costs will rise for the next 50 years at the same rate they’ve risen for the last 50 years. Eventually, the people rationed out of health care will go from the working poor, to the middle class, to the old folks, unless something is done to contain costs. Sorting out what medical treatments actually work (as opposed to what medical treatments are no better than placebos, or magic) is, to me, a better system of cutting costs than just letting costs rise sky-high, to a point at which most people are priced right out of “the system that works.”

@Nullo They actually have. Thing is though, many operate on a sliding scale, which some consider worse than Socialism, and may treat truly low-income people for free at the expense of more well-off people.
Also, the doctors there tend to earn rather modest incomes; they drive Camrys instead of Benzs.